Neuraxial Modulation for Refractory Ventricular Arrhythmias
Top Cited Papers
Open Access
- 1 June 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 121 (21), 2255-2262
- https://doi.org/10.1161/circulationaha.109.929703
Abstract
Background— Reducing sympathetic output to the heart from the neuraxis can protect against ventricular arrhythmias. The purpose of this study was to assess the value of thoracic epidural anesthesia (TEA) and left cardiac sympathetic denervation (LCSD) in the management of ventricular arrhythmias in patients with structural heart disease. Methods and Results— Clinical data of 14 patients (25 to 75 years old, mean±SD of 54.2±16.6 years; 13 men) who underwent TEA, LCSD, or both to control ventricular tachycardia (VT) refractory to medical therapy and catheter ablation were reviewed. Twelve patients were in VT storm, and 2 experienced recurrent VT despite maximal medical therapy and catheter ablation procedures. The total number of therapies per patient before either procedure ranged from 5 to 202 (median of 24; 25th and 75th percentile, 5 and 56). Eight patients underwent TEA, and 9 underwent LCSD (3 patients had both procedures). No major procedural complications occurred. After initiation of TEA, 6 patients had a large (≥80%) decrease in VT burden. After LCSD, 3 patients had no further VT, 2 had recurrent VT that either resolved within 24 hours or responded to catheter ablation, and 4 continued to have recurrent VT. Nine of 14 patients survived to hospital discharge (2 TEA alone, 3 TEA/LCSD combined, and 4 LCSD alone), 1 of the TEA alone patients underwent an urgent cardiac transplantation. Conclusions— Initiation of TEA and LCSD in patients with refractory VT was associated with a subsequent decrease in arrhythmia burden in 6 (75%) of 8 patients (68% confidence interval 51% to 91%) and 5 (56%) of 9 patients (68% confidence interval 34% to 75%), respectively. These data suggest that TEA and LCSD may be effective additions to the management of refractory ventricular arrhythmias in structural heart disease when other treatment modalities have failed or may serve as a bridge to more definitive therapy.This publication has 29 references indexed in Scilit:
- Video-Assisted Thoracoscopic Cardiac Denervation: A Potential Novel Therapeutic Option for Children With Intractable Ventricular ArrhythmiasThe Annals of Thoracic Surgery, 2008
- The Role of the Autonomic Nervous System in Sudden Cardiac DeathProgress in Cardiovascular Diseases, 2008
- Long QT syndrome: an indication for cervicothoracic sympathectomyCardiovascular Surgery, 1995
- Thoracic Epidural Anesthesia Attenuates Halothane-induced Myocardial Sensitization to Dysrhythmogenic Effect of Epinephrine in DogsAnesthesiology, 1995
- Site of Hemodynamic Effects of Intrathecal α2-Adrenergic AgonistsAnesthesiology, 1991
- Thoracic epidural anaesthesia decreases the incidence of ventricular arrhythmias during acute myocardial ischaemia in the anaesthetized ratActa Anaesthesiologica Scandinavica, 1988
- Efficacy of left cardiac sympathectomy in the treatment of patients with the long QT syndrome.Circulation, 1984
- THE RATIONALE AND THE ROLE OF LEFT STELLECTOMY FOR THE PREVENTION OF MALIGNANT ARRHYTHMIASAnnals of the New York Academy of Sciences, 1984
- Left stellectomy and denervation supersensitivity in conscious dogsThe American Journal of Cardiology, 1982
- Effects of unilateral cardiac sympathetic denervation on the ventricular fibrillation thresholdThe American Journal of Cardiology, 1976